Quick-read summary
Being overweight or obese (having excess weight) is very common amongst people living with severe mental illnesses, such as schizophrenia, and this often leads to health complications and early death.
This study focussed on secure mental health settings, where people with severe mental illness are cared for in locked wards. It aimed to explore the influences and challenges around weight management.
We used a mixed-methods approach involving a survey, focus group and interviews, and ethnographic in-person observations in the hospital setting.
Overall, we found that secure mental healthcare delivers an ‘obesogenic’ environment, where it is very difficult for patients to become and stay a healthy weight.
In future, broad interventions that address different aspects of this environment and the hospital culture, are likely to be needed to avoid obesity and promote healthier behaviours.
Who is this evidence useful for?
This evidence is useful for policymakers and practitioners involved in delivering healthcare in secure mental health settings, and health professionals seeking to promote healthy weight and reduce health inequalities.
The findings are also relevant to people living with mental illness and their families and carers, to help understand why excess weight is common and what we might do differently in future.
What is the issue
People living with severe mental illness, such as schizophrenia and related psychotic disorders, often experience overweight and obesity (excess weight). This challenge is most extreme amongst patients in secure mental health settings, who are held in locked wards due to the risks posed to themselves and others.
Research summary
This programme of work involved collaboration between Newcastle University and Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, through four linked approaches.
We undertook an online survey of staff in secure settings and received responses from across different parts of the service.
These findings informed ethnographic in-person observations undertaken in a low-secure ward over a six-month period.
We then held focus groups with current patients, former patients, carers and multidisciplinary staff. We conducted semi-structured interviews with staff at Tees, Esk and Wear Valleys NHS Trust, to gain the perspective of a second, complementary mental health trust.
Finally, we brought all this data together to integrate everyone’s views and experiences, and consider how we might deliver care better in future.
What the research found
- Overall, our research showed that patients in secure services live in an environment and culture which makes it much easier to be overweight or obese, rather than a healthy weight.
- We identified particular problems such as: medication causing people to gain weight, patients being inactive for most of the time, dislike of hospital meals, and choosing unhealthy food alternatives. Patients often experience low motivation to change, the hospital wards are understaffed, and it is difficult to strike a balance between giving patients choice and promoting healthy options.
- In future, rather than focusing on one small issue, we need to develop plans and activities that include everyone involved in secure patient care, and address the whole range of current problems causing unhealthy weight.
Why is this important?
People with severe mental illness often die 15-20 years earlier than the wider population, generally due to their physical health conditions, which are often caused by excess weight.
Given that patients tend to stay for a long time in secure hospitals – often several years – it is particularly important to promote healthy environments here.
Developing a clear understanding of the factors that make it more likely for patients to develop overweight and obesity will help us to provide healthier secure mental health settings in future.
How were people/patients involved in this work?
People with lived experience of severe mental illness, and who had spent time in secure mental healthcare, were part of the steering group leading this research. People with lived experience also participated in the data integration and analysis group who developed the overarching research findings.
What’s next?
- Building on the learning from this research, we plan to work with patients, carers and staff to develop an intervention suitable for secure mental health settings, to help patients achieve and stay a healthy weight.
- Next, we would like to apply these findings to support people living with severe mental illness outside of hospital, in the wider community, to live a healthy lifestyle and maintain a healthy weight.
Get in touch about this research
Contact Dr Susanna Mills, Newcastle University and Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust.
susanna.mills@newcastle.ac.uk or susanna.mills@cntw.nhs.uk
You can read the full research papers, below.
Funding statement
This research was supported through a Starter Grant for Clinical Lecturers for Dr Susanna Mills, funded by the Academy of Medical Sciences [SGL0251005]
Co-authors
Professor Eileen Kaner, Newcastle University
Professor Sheena Ramsay, Newcastle University
Dr Iain McKinnon, Newcastle University and Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust